Obesity is an epidemic in the United States. It presents health risks, which often requires more medical care. In addition to the need for increased care, the size and shape of the body impacts the quality of medical care. This is particularly true for medical procedures that require access to the abdomen or groin area when the patient has developed a pannus.
A pannus is a region of loose skin and fatty tissue in the lower abdomen. It descends below the abdomen and appears as an apron often obscuring the abdomen and groin area due to its lack of musculature and mass. It can be a serious obstacle for any doctor that is attempting to examine, treat or otherwise access that area of the patient, particularly in surgical procedures such as a cesarean section. Further, when the doctor is performing a surgical procedure, it is necessary that it be done in a sterile environment and preferably with devices that maintain and encourage a sterile environment, particularly at an incision site.
Current operating room procedures for handling a pannus are limited and ineffectual, particularly for cesarean sections. In some instances, the pannus is restrained using tape to lift it out of the groin region. The tape attaches the pannus to the body itself or attaches to the bedrail. The tape is several strips running along the body. This is not comfortable to the patient and the practice is unreliable as the tape is unable to reliably maintain the retraction under the weight of the pannus, which often releases itself during the procedure, making it difficult to maintain sterility of the surgical field. The sudden release of the pannus is also dangerous as it may obstruct the incision site as the physician is performing the procedure. Other times, medical professionals simply proceed with the medical procedure while attempting to work around, over, and through the pannus. This is also dangerous as a large pannus significantly obscures the view. And, as with the makeshift taping practice, it presents issues with maintaining sterility as the medical professional is forced to interact with parts of the body that are not necessarily a part of the surgical field.
Many surgical procedures employ a surgical incise drape to maintain sterility. Typically, the surgical area of the patient is cleaned and treated with an antimicrobial. The surgical site is then squared-off using a surgical drape that has an opening that is larger than the expected size of the incision. An incise material is then used to cover all or a portion of the patient's skin left exposed by the surgical drape. The incise material helps to reduce the migration of germs into the incision site. This is necessary because the skin's pores still contain germs and bacteria that can migrate to the surface as the skin is moved and worked during the course of a surgical procedure despite cleansing of the skin. By covering the skin with incise material, a lower incidence of surgical site contamination occurs.
Surgical incise drapes are well known in the art. In their simplest form, they are a clear polymeric body portion with an adhesive on one side that is covered by a release liner. There are two suppliers of incise drapes: Minnesota Mining and Manufacturing Company, St. Paul, Minn., and T. J. Smith and Nephew Ltd. Examples of incise material can be found in U.S. Pat. Nos. 4,310,509; 4,323,557; 4,452,845; Re. 31,886; and Re. 31,887. These incise drapes, however, function strictly to provide a sterile environment. They have no functionality for retraction of a pannus.
U.S. Pat. No. 7,938,121 provides an abdominal restraint (tension band) that includes a base and a support. The abdominal restraint may include a lateral member that is selectively attachable to a longitudinal member that may be attached to an operating or examining table. This device presents challenges. First, it does not provide protection from contamination from bacteria that can be found on other portions of the patient's body or that may be airborne or conveyed by the surgical staff. Second, given that the abdominal restraint is made of an opaque tension band, it may interfere with the incise site or obscure the doctors view. U.S. Publication 20100145155 discloses a garment in the shape of a girdle or athletic shorts with apertures on the front of the garment such that the apertures expose the inguinal regions of a patient. The garment may include an upper portion that allows for retraction of the pannus. This device is also problematic as it works as a garment, inhibiting access to certain incision sites. It is also problematic as it is difficult to dress and undress the patient, particularly after a surgical procedure.
As such, there is a need for a pannus retraction device that can retract and retain the pannus from the lower abdominal/groin area and maintain sterility while the medical professional exams or treats the patient. The retractor should be flexible and elastomeric to provide comfort to the patient. The retractor should also allow the physician to cut though it if necessary. The present invention serves these purposes.
The abdominal elevator of the present invention retracts and retains the pannus while providing a completely sterile field with an unobstructed view of the incision site. The abdominal elevator comprises a body portion made from a flexible foam, paper, polymer, or fabric having at least one upper edge and, optionally, two or more side edges, with a shape ranging from triangular to rectangular to oval with one or more straps attached to one or more of the edges and also having an anterior surface and a posterior surface having a adhesive applied to the posterior surface. The abdominal elevator of the present invention is flexible and comfortable for the patient.